1. A woman with multiple mononeuropathies and eosinophilia Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

2. Vignette A 57-year-old woman with asthma, nasal polyps and allergies, presented with acute lancinating pain and patchy weakness in the distribution of multiple upper and lower limb peripheral nerves. She had peripheral eosinophilia (2x10 9 /L). Sural nerve biopsy demonstrated nerve large- arteriolar necrotizing vasculitis with eosinophils (Figure 1). Kassardjian et al. © 2014 American Academy of Neurology

3. Imaging Kassardjian et al. © 2014 American Academy of Neurology

4. Eosinophilic infiltration and necrotizing vasculitis on nerve biopsy in Churg-Strauss syndrome Sural nerve biopsy is consistent with Churg- Strauss syndrome (CSS), renamed eosinophilic granulomatosis with polyangiitis. CSS is a systemic vasculitis involving small to medium-sized vessels, associated with asthma, chronic rhinosinusitis and eosinophilia. Peripheral neuropathy occurs in 60-70% of cases, and nerve biopsy may show intravascular and extravascular granulomas 1. 1 Eosinophilic inflammation in nerve is rare, occurring in approximately 15% of biopsies 2. 2 Kassardjian et al. © 2014 American Academy of Neurology